Transcatheter aortic valve implantation in elderly patients with severe aortic stenosis and rheumatic phenotype.

Abstract

Significant fibrosis is characteristic of rheumatic aortic valve disease that affects anchoring and deployment of the trans-catheter heart valve. Our goal was to determine whether trans-catheter aortic valve implantation (TAVI) is an effective treatment option for severe aortic stenosis patients with rheumatic valvular disease. This study is a prospective cohort study that includes a total of 54 rheumatic severe aortic stenosis patients who were referred for TAVI. The age ranged from 65.00 to 83.00 years (mean age 72.75 ± 5.86 years). Notably, 63% of the patients had undergone preimplantation balloon dilatation. The outcomes included total new conduction disturbances (transient and permanent defects of atrio-ventricular block and left bundle branch block) in 31.4% of the patients, permanent pacemaker implantation in 3.7%, and valve embolization in 1.85%, and no patients had moderate to severe para-valvular leak. All-cause death within a 6-month follow-up was 3.7%. This cohort was then compared to a propensity score matched group of degenerative calcific severe aortic stenosis of 54 cases revealing comparable post-procedural results. Compared with the outcomes of TAVI in patients with degenerative aortic stenosis, TAVI represents a viable and durable option for rheumatic severe aortic stenosis patients.